Avoidant Personality Disorder

Feeling shy around other people is normal. Usually, avoidant personality disorder means that we are aware of others and our environment. Most of us experience being in a room full of people we don’t know. For example on our first day of school or a new workplace. Eventually, we learn to manage on our own. It is also normal to have days when we want to withdraw from social interactions entirely. Sometimes we prefer our own company, or we are simply not social butterflies like other people.

However, it becomes a problem when this behaviour becomes the default coping mechanism for every social encounter. Thereafter it starts affecting how we work, our relationships, and how we perceive others.

Avoidant Personality Disorder vs Shyness/Social Awkwardness

Shyness vs Avoidant Personality Disorder

Do you have a friend who cancels plans or refuses to go out because they prefer to be by themselves? What about when someone is noticeably quiet when they go to parties or meet new people? All of these can be normal responses to new situations. It’s difficult meeting strangers and getting to know them. Why? Because we don’t know what kind of person they are yet, especially when you are the type of person who feels happier in their own company.

People can be shy around strangers. However,  with their friends. They act as if that shyness had never existed, to begin with. They’re capable of feeling comfortable around their friends. They have no trouble making new ones after getting past their first hesitations. Some people are even more prone to fumble in social interactions than others and act awkward. However, they brush it off. It would not stop them from trying to make new friends.

This is different from Avoidant Personality Disorder (AVPD). You would find yourself withdrawing from others. Believing that it would be better to avoid people entirely rather than experience being rejected. You may even believe you may not be enough for others to accept you and stop trying. Despite people acting otherwise. It can be hard living with AVPD because even if you want to build relationships with others, your negative thoughts about yourself and fears stop you from doing so.

Signs & Symptoms in Avoidant Personality Disorder

But it is reasonable to consider the diagnosis if you or someone you know presents with the following characteristics:

  • Overly sensitive towards criticism, whether it is constructive or not
  • Has a select few friends, and scared of making more unless they are sure they will not be rejected
  • Wants companionship but withdraws themselves due to their fear of rejection or feelings of inadequacy
  • Cannot deepen relationships with people due to fears of shame and ridicule
  • Avoids social settings, or any event involving other people
  • Exaggerates or catastrophizes potential problems in social encounters
  • Associated with terms like “People pleasers” or “Inferiority Complex”
  • Poor self-image and overly conscious in social situations

How would someone with Avoidant Personality Disorder think?

Social Cognition

Mentalization is the ability of someone to read into what drives other peoples’ behaviour and emotions. They would experience deficits in mentalization, causing them to misconstrue other people’s intentions, thus affecting their self-esteem and social skills. They also have deficits in their ability to be aware of, regulate, and express their emotions, called affect consciousness. Because of this, they try to protect themselves from emotional pain by avoiding emotions entirely. Ultimately, their skewed social cognition makes them more conscious of themselves and how people see them. In addition, they are less self-reflective of their thoughts and actions.

Self-concept

After repeated instances of disappointing relationships, we can often think maybe we are the problem. In addition, failed relationships with others can leave us thinking less of ourselves. This is a common thought. People with avoidant personality disorder present with “malignant self-regard”. Which means they may present with masochistic, self-defeating, and depressive personality styles. More than low self-esteem, they experience a sense of personal inadequacy.

Fear of Rejection

Being rejected can feel like one of the most heartbreaking experiences for people. So it is only natural we would want to avoid it. However, that fear of rejection can be used in a way that suppresses emotional expression. This happens for people with an avoidant personality disorder. Others however view it as a sign that they are not interested or lacking in compassion. This, as a result, increases the risk of rejection by others and the cycle repeats itself.

Causes of Avoidant Personality Disorder

There are different theories of personality involved when it comes to finding the cause of a mental disorder. Many of them are biopsychosocial in nature. Meaning that it is physical, psychological, and social factors that affect the development of mental disorders. For Avoidant Personality Disorder, it can be divided into four factors:

Early childhood experiences

The way you were raised can affect how your personality develops later in life. Children’s thoughts and beliefs are easily moulded by caregivers with who they interact within their growing years. This can be their parents, grandparents, or teachers. Studies have shown that caregivers who are less affectionate and encouraging of achievements, were more likely to raise children who develop an avoidant personality disorder.  Secondly, parents who were more rejecting and guilt-engendering were also likely to raise children with these traits. 

While parents who are neglectful and abusive (emotionally and/or physically) can increase the chance of developing AVPD. In addition, those who are overprotective can also contribute to AVPD. That is because both of these upbringings build the idea in their children that they need to suppress their own wants. that they need to avoid negative consequences like abuse.

Attachment style

Attachment styles are how people handle their relationships with others. It is based on how they were treated in their childhood by their main caregiver. These styles can manifest all the way into adulthood, regardless of whether they are constructive or not. An avoidant attachment style contributes to the incidence of AVPD. Partly due to its association with the development of negative self-concepts and fear of intimate relationships.

But there is also a fearful attachment style that promotes a desire for intimate relationships but a feeling of distrust and fear of rejection. This is characteristic in people with AVPD. It has also been shown to be the most disabling. It is associated with negative feelings towards the self and other people. If early caregivers are critical, demeaning, and neglectful, it may teach the child that other people will treat them the same way. Thus affecting their relationships with other people.

Temperamental factors

Some temperaments make people susceptible to developing AVPD. They refer to a person’s natural inclination towards specific behaviours not influenced by their learning, values, and attitudes. They can increase a child’s vulnerability towards avoidant coping mechanisms and even put them at risk for negative childhood experiences. The temperaments founded to be connected to AVPD include:

  • Personality rigidity
  • Hypersensitivity
  • High harm avoidance
  • Low novelty-seeking
  • Overactive behavioural inhibition system
  • Moody or easily agitated
  • Shyness
  • Low social approach & high social avoidance

 

Genetic factors

Genetic studies suggest that heredity can play a part in developing AVPD. But while you may be biologically predisposed to AVPD, the chances of symptoms manifesting are low. Environmental factors together with genetics bring about the coping mechanisms relating to AVPD.

Avoidant Personality Disorder Diagnosis

There are no laboratory tests for diagnosing personality disorders. The 5th edition of the  Diagnostic and Statistical Manual of Mental Disorders (DSM-5 criteria) makes the diagnosis of AVPD. The most important and distinct symptoms present in AVPD are feelings of inadequacy. Secondly, the fear of rejection, and thirdly social inhibition.

Symptoms

People with avoidant personality disorder are usually diagnosed as adults because children are usually still forming their personalities. They may still have time to outgrow their behaviours. Some psychologists make use of validated and reliable assessment questionnaires. These help accurately test whether your symptoms match those required to diagnose Avoidant Personality Disorder.

Avoidant Personality Disorder Treatment

Many people with symptoms of avoidant personality disorder do not seek help. unless they begin experiencing symptoms of depression or anxiety. It is also likely they will stop treatment once those symptoms alleviate. Like other personality disorders, they often are not aware that their behaviour is a problem.

Avoidant Personality Disorder treatment involves mostly psychotherapy rather than prescribed medications. Unless you are experiencing comorbid disorders or debilitating symptoms like anxiety and depression. If medications are involved, they must be coupled with psychotherapy. This is because the root of the problem lies in their deep-rooted thoughts and subsequent behaviours.

Cognitive Behavioral Therapy (CBT)

CBT is one of the most widely-used therapies for people with personality disorders. As the name “cognitive-behavioural” suggests. It aims to change unhealthy thinking patterns and change coping behaviours. Both of which are at the root of personality disorders. For avoidant personality disorder, you can do it individually, in groups, or both if deemed necessary.

For individual CBT, a more cognitive approach is useful. This is under the basis that your behavioural problems are based on dysfunctional thought processes and irrational belief systems. This involves cognitive restructuring, where you and the therapist will identify irrational or maladaptive thoughts together, then work to accept a rational conclusion.

There is also group CBT that will have a more behavioural approach. This is to take advantage of the presence of other people in the group. This involves gradual exposure, where you need encouragement to take on situations you normally avoid. Also, social skills training, where you will discuss and practice interacting with others appropriately and effectively.

Psychodynamic Therapy

Psychodynamic therapy places emphasis on the root of negative thinking. It does so by bringing to light events from the past that have caused pain and conflict for people with personality disorders. This would allow you to become more self-aware of the causes of your symptoms and rationalize where they arise from. This type of therapy focuses on five important concepts:

  1. Affect and emotion
  2. Past experiences
  3. Patterns and themes of relationships
  4. Relationship between the client and therapist
  5. Transference and resistance within the client-therapist relationship

One of the most characteristic parts of psychodynamic therapy is the last two concepts. Primarily, because it recognizes that clients tend to place their feelings about their significant relationships onto the therapist, whether they know it or not. For example, if you view others with distrust and fear of rejection, you would view the therapist the same way at first. This allows the therapist to give you a new experience through the relationship you’ll build together. So that you can generalize it with other interpersonal relationships in the future.

Schema Therapy

This therapy builds on CBT and other therapies while focusing on the therapist-client relationship. The aim of this therapy is to improve daily functioning through behaviour. Also, similar to CBT, while addressing their misconstructions of previous experiences like psychodynamic therapy. A key feature here involves “limited reparenting” wherein the client learns four concepts:

  1. How dysfunctional schemas are repeated throughout their life
  2. Coping styles they learned in their childhood
  3. Schema modes (i.e., mindset and coping styles) being used for coping and how they cause more harm than good
  4. Developing better coping skills and meeting emotional needs

Relationship with…

Schizoid Personality Disorder 

Although commonly mistaken for the other, the stark contrast between schizoid and avoidant personality disorder is that people with the former have no interest in dealing with others, while those with the latter long for companionship.

Social Anxiety Disorder (SAD) 

This is another diagnosis mistaken for avoidant personality disorder but can exist comorbidly. While both involve social interactions. People with social anxiety disorder however have the fear of embarrassing themselves when performing in front of others. “Performing” can refer to even normal social interactions where they can embarrass themselves. People with avoidant personality disorder, however, have hypersensitivity towards being rejected by others. Both SAD and AVPD can be present in a person.

Depression 

This is a common disorder present in people with AVPD and is associated with higher chances of suicidal ideation and attempts making AVPD a predictor for chronic depression. In the same way, both disorders are a result of maladaptive coping behaviours. In addition, they also promote the cycle of negative thoughts and self-concepts.

How can a psychologist, psychiatrist, or mental health professional help?

How can Psychologists and Psychiatrists help you?

Psychologists and psychiatrists are trained to provide psychotherapy to their clients and address their cognitive, behavioural, and social concerns associated with various mental disorders. They can diagnose avoidant personality disorder and treat it with appropriate therapies. They can also help you understand the cognitive, behavioural, and social factors that affect your condition. Also, bring to light coping strategies and skills specifically made for you and your condition.

Sometimes there are underlying disorders such as depression or anxiety that are exacerbating the client’s symptoms. A psychiatrist will be helpful in providing medications for those comorbid disorders. A psychiatrist, as a medical doctor, can provide insight as to the connection between physical and mental health.

Oftentimes, treatment will involve the cooperation of friends, family, and other circles of support for the client. This will educate you about your condition. As well as how to guide you in your recovery and compliance to your course of treatment. 

Prevention

Unlike physical ailments, mental disorders can be hard to prevent because usually, their root cause stems from events in the past that can no longer be changed. What can be changed, however, is our awareness of these symptoms. If you or anyone you care about presents with these kinds of thoughts and behaviours. It may be helpful to seek early treatment for a better outcome.

Contact our friendly support team if you would like to see a psychologist or a psychiatrist. Our experienced mental health professional can help diagnose and treat people who are avoidant. You can send us an email, webchat inquiry or call us during business hours.